Diagnostic accuracy of hospitalist-performed hand-carried ultrasound echocardiography after a brief training program.

Background: The duration of training needed for hospitalists to accurately perform hand-carried ultrasound echocardiography (HCUE) is uncertain.

Objective: To determine the diagnostic accuracy of HCUE performed by hospitalists after a 27-hour training program.

Design: Prospective cohort study.

Clinical trial of standing-orders strategies to increase the inpatient influenza vaccination rate.

We compared strategies to increase the rate of influenza vaccination. A written standing-orders policy that enabled nurses to vaccinate patients was compared with augmentation of the standing-orders policy with either electronic opt-out orders for physicians or electronic reminders to nurses. Use of opt-out orders yielded the highest vaccination rate (12% of patients), followed by use of nursing reminders (6%); use of the standing-orders policy alone was ineffective.

Use of clinical decision support to increase influenza vaccination: multi-year evolution of the system.

Despite recognition that clinical decision support (CDS) can improve patient care, there has been poor penetration of this technology into healthcare settings. We used CDS to increase inpatient influenza vaccination during implementation of an electronic medical record, in which pharmacy and nursing transactions increasingly became electronic. Over three influenza seasons we evaluated standing orders, provider reminders, and pre-selected physician orders.

Evolution of clinical decision support to increase influenza vaccination.

Over three influenza seasons spanning four years we evaluated the effect of standing orders, reminders, and iterations of Clinical Decision Support (CDS) to increase influenza (flu) vaccination among inpatients. Using CDS, coverage increased over each season: (0%, 12%, 35%). However, success was realized only after integration of the electronic medication administration record (E-MAR).

House staff attitudes about influenza vaccination after participation in a clinical trial to improve vaccination of hospital patients.

We surveyed house staff who had participated in a trial that compared influenza vaccination strategies for inpatients. House staff who were exposed to computer-generated vaccination orders were more likely to report that they recommended vaccination to their inpatients and outpatients, compared with house staff who were not exposed to a vaccination intervention. Also, house staff did not recognize pregnant women as a high-priority population for influenza vaccination.

Firm-based trial to improve central venous catheter insertion practices.

Background: Central venous catheters placed in femoral veins increase the risk of complications. At our institution, residents place most catheters in the femoral vein.

Objective: Determine whether a hands-on educational session reduced femoral venous catheterization and improved residents' confidence and adherence to recommendations for infection control.

Prospective cohort study of central venous catheters among internal medicine ward patients.

Background: Central venous catheter (CVC) use is less well described for patients outside the intensive care unit. We evaluated CVCs and the associated bloodstream infection rate among patients admitted to the general medical service.

Methods: We performed a prospective cohort study of patients who had a CVC on admission or inserted during their stay on the general medical service in a public teaching hospital, November 15, 2004, to March 31, 2005.

Azithromycin for acute bronchitis: a randomised, double-blind, controlled trial.

Background: The value of azithromycin for treatment of acute bronchitis is unknown, even though this drug is commonly prescribed. We have investigated this question in a randomised, double-blind, controlled trial.

Methods: Adults diagnosed with acute bronchitis, without evidence of underlying lung disease, were randomly assigned azithromycin (n=112) or vitamin C (n=108) for 5 days (total dose for each 1.